Comparison of Voice and Swallowing Parameters After Endoscopic Total and Partial Arytenoidectomy for Bilateral Abductor Vocal Fold Paralysis

Yılmaz, Taner; Süslü, Nilda; Atay, Gamze; Özer, Serdar; Günaydın, Rıza Önder; Bajin, Münir Demir

doi:10.1001/jamaoto.2013.3395

Cited by 32 publications

(35 citation statements)

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“…La elección de esta técnica en lugar de las técnicas que buscan la lateralización de una cuerda vocal se basa en que se obtienen resultados comparables, pero con una menor morbilidad y con un procedimiento más corto y sencillo. Consideramos que otras técnicas de resección como la aritenoidectomía [2, [18][19][20] son más agresivas y mantienen una tasa de complicaciones mayor y otras como la cordotomía pueden no ser suficientemente amplias para obtener un adecuado diámetro glótico en el caso de pacientes con laringes estrechas o necesitar de procedimientos bilaterales lo que puede dificultar la cicatrización o producir un mayor número de eventos aspirativos [3]. Respetar la integridad de los aritenoides y de la comisura posterior así como de las estructuras supraglóticas disminuye la tasa de posibles complicaciones [21,22].…”

Section: Resultsunclassified

Cordectomía posterior en el tratamiento de la parálisis bilateral de cuerdas vocales. ¿Debe ser la edad una limitación en su indicación?

2016

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Section: Resultsunclassified

Cordectomía posterior en el tratamiento de la parálisis bilateral de cuerdas vocales. ¿Debe ser la edad una limitación en su indicación?

2016

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“…The other most important symptom is usually dysphonia. Due to the gap between the VFs, voice quality may be better than in the case of unilateral VF paralysis, but a monotonous voice and speaking pattern characterized by short and hurried words followed by stridor of frequent frequency spectrum is not rare [19]. Dysphagia, aspiration and pain in the neck region may also be seen [3].…”

Section: Discussionmentioning

confidence: 99%

“…In fact the exact mechanism of this condition is not known but it has been suggested that chemical denervation of active CT muscles may produce flaccidity in the VFs (Fig. 1) and cause a minimal increase in glottic section area [9,18,19]. This increase, though minimal, may improve respiratory distress even in patients with life-threatening levels of distress.…”

Section: Discussionmentioning

confidence: 99%

Electromyography-Guided Botulinum Toxin Injection Into the Cricothyroid Muscles in Bilateral Vocal Fold Abductor Paralysis

Şahin

Aydoğdu

Akyıldız

et al. 2017

Clin Exp Otorhinolaryngol

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ObjectivesBilateral vocal fold abductor paralysis (BVFAP) both deteriorates quality of life and may cause life-threatening respiratory problems. The aim of this study was to reduce respiratory symptoms in BVFAP patients using cricothyroid (CT) botulinum toxin (BTX) injection.MethodsBefore and 2 weeks and 4 months after bilateral BTX injection into the CT muscles under electromyography; alterations in respiratory, acoustic, aerodynamic and quality of life parameters were evaluated in BVFAP patients with respiratory distress. For the respiratory evaluation modified Borg scale and spirometry, for the voice and aerodynamic evaluations Voice Handicap Index-30 (VHI-30), GRBAS, acoustic analysis (sound pressure level, F0, jitter%, shimmer%, noise-to-harmonic ratio) and maximum phonation time and for the quality of life assessment Short Form-36 (SF-36) form were used.ResultsAll patients were female with a mean age of 47±8.1 years. There was a mean time of 11.8±5.5 (minimum 2, maximum 23) months between BVFAP development and BTX injection. In all cases, other than one case with unknown aetiology, the cause of vocal fold paralysis was prior thyroid surgery. In total 18.6±3.1 units of BTX were applied to the CTs. In the preinjection period, and the 2nd week and 4th month after injection, the Borg dyspnea scale was 7.3/5.3/5.0, FIV1 (forced inspiratory volume in one second) was 1.7/1.7/1.8 L, peak expiratory flow (PEF) was 1.4/1.7/2.1 L/sec, maximum phonation time was 7.0/6.4/6.2 seconds and VHI-30 was 63.2/52.2/61.7 respectively. There was no significant alteration in acoustic analysis parameters. Many of the patients reported transient dysphagia within the first week. There were insignificant increases in SF-36 sub-scale values.ConclusionAfter BTX injection, improvements in the mean Borg score, PEF and FIV1 values and SF-36 sub-scale scores showed the restricted success of this approach. This modality may be kept in mind as a transient treatment option for patients refused persistent tracheotomy or ablative airway surgeries.

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“…In a trial of 20 patients with BVFP randomized between total and partial (resecting the vocal process and anterior body) arytenoidectomies, Yilmaz et al [20] found that neither approach had different results regarding success rate, VHI-30 questionnaire scores, aerodynamic, acoustic analysis, or FOSS. The single distinction found was the length of the procedure: partial arytenoidectomy took 10 minutes longer to perform on average.…”

Section: Discussionmentioning

confidence: 99%

Total and Partial Laser Arytenoidectomy for Bilateral Vocal Fold Paralysis

Yılmaz

Altuntaş

Süslü

et al. 2016

BioMed Research International

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Introduction. Treatment for bilateral vocal fold paralysis (BVFP) has evolved from external irreversible procedures to endolaryngeal laser surgery with greater focus on anatomic and functional preservation. Since the introduction of endolaryngeal laser arytenoidectomy, certain modifications have been described, such as partial resection procedures and mucosa sparing techniques as opposed to total arytenoidectomy. Discussion. The primary outcome measure in studies on BVFP treatment using total or partial arytenoidectomy is avoidance of tracheotomy or decannulation and reported success ranges between 90 and 100% in this regard. Phonation is invariably affected and arytenoidectomy worsens both aerodynamic and acoustic vocal properties. Recent reports indicate that partial and total arytenoidectomies have similar outcome in respect to phonation and swallowing. We use CO2 laser assisted partial arytenoidectomy with a posteromedially based mucosal flap for primary cases and reserve total arytenoidectomy for revision. Lateral suturing of preserved mucosa provides tension on the vocal fold leading to better voice and leaves no raw surgical field to unpredictable scarring or granulation. Conclusion. Arytenoidectomy as a permanent static procedure remains a traditional yet sound choice in the treatment of BVFP. Laser dissection provides a precise dissection in a narrow surgical field and the possibility to perform partial arytenoidectomy.

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Comparison of Voice and Swallowing Parameters After Endoscopic Total and Partial Arytenoidectomy for Bilateral Abductor Vocal Fold Paralysis

Abstract: clinicaltrials.gov Identifier: NCT01824849.

Cited by 32 publications

References 12 publications

Cordectomía posterior en el tratamiento de la parálisis bilateral de cuerdas vocales. ¿Debe ser la edad una limitación en su indicación?

Cordectomía posterior en el tratamiento de la parálisis bilateral de cuerdas vocales. ¿Debe ser la edad una limitación en su indicación?

Electromyography-Guided Botulinum Toxin Injection Into the Cricothyroid Muscles in Bilateral Vocal Fold Abductor Paralysis

Total and Partial Laser Arytenoidectomy for Bilateral Vocal Fold Paralysis

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